Discusses transient ischemic attack (TIA), sometimes called a mini-stroke. Covers causes, including blood clot as a result of atherosclerosis. Looks at treatment with medicines, surgery, and lifestyle changes. Discusses prevention steps.

Transient Ischemic Attack (TIA)

Topic Overview

What is a transient ischemic attack (TIA)?

Some
people call a transient ischemic attack (TIA) a mini-stroke, because the
symptoms are like those of a
stroke but don't last long. A TIA happens when blood
flow to part of the brain is blocked or reduced, often by a blood clot. After a
short time, blood flows again and the symptoms go away. With a stroke, the
blood flow stays blocked, and the brain has permanent damage.

A
TIA is a warning: it means you are likely to have a stroke in the future. If
you think you are having a TIA, call 911. Early treatment can help prevent a
stroke. If you think you have had a TIA but your symptoms have gone away, you
still need to call your doctor right away.

What are the symptoms?

Symptoms of a TIA are the same as symptoms of a stroke. But symptoms of a TIA occur suddenly and don't last very long. Most of the time, they go away in 10 to 20 minutes. They may include:

Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.

Sudden vision changes.

Sudden trouble speaking.

Sudden confusion or trouble understanding simple statements.

Sudden problems with walking or balance.

A sudden, severe headache that is different from past headaches.

What causes a transient ischemic attack?

A blood
clot is the most common cause of a TIA. Blood clots can be the result of
hardening of the arteries (atherosclerosis),
heart attack, or
abnormal heart rhythms. Brain cells are affected
within seconds of the blockage. That causes symptoms in the parts of the body
controlled by those cells. After the clot dissolves, blood flow returns, and the
symptoms go away.

Sometimes a TIA is caused by a sharp drop in
blood pressure that reduces blood flow to the brain. This is called a
"low-flow" TIA. It is not as common as other types.

What tests do you need after a TIA?

Your doctor will
do tests to look at your heart and blood vessels. You may need:

Your doctor will also check to see if something else is
causing your symptoms.

How is a TIA treated?

Your doctor will start you on
medicines to help prevent a stroke. You may need to take several
medicines.

If tests show that the blood vessels (carotid arteries) in your neck are too narrow, you may
need surgery to open them up (carotid endarterectomy). This can help prevent
blood clots that block blood flow to your brain.

Another type of surgery is
carotid artery stenting. During this surgery, the doctor puts a small tube
called a
stent inside your carotid artery. This helps keep the
artery open. Carotid artery stenting is not as common as endarterectomy.

How can you prevent another TIA or stroke?

After you have had a
TIA, you are at risk for having another TIA or a stroke. But you can make some important
lifestyle changes that can reduce your risk of stroke and improve your overall
health.

Treat any health problems you have

Manage high blood pressure or high cholesterol by working with your doctor.

Manage diabetes. Keep your blood sugar levels within a target range.

If your doctor recommends that you take aspirin or a blood thinner, take it. This can help prevent a stroke.

Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

Don't smoke or allow others to smoke around you.

Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

Stay at a healthy weight. Being overweight makes it more likely that you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.

Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.

Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, fish, and foods that are low in sodium, saturated fat, trans fat, and cholesterol.

Also, an artery that is partially blocked with
plaque can reduce blood flow to the brain and cause
symptoms.

Rare causes of blood clots that can cause a TIA include:

Clumps of bacteria, tumor cells, or air bubbles
that move through the bloodstream.

Conditions that cause blood
cells to stick together. For example, having too many red blood cells (polycythemia), abnormal
clotting factors, or abnormally shaped red blood
cells, such as those caused by
sickle cell disease, may cause blood clots to form.

Inflammation in the blood vessels, which may develop from
conditions such as
syphilis,
tuberculosis, or other inflammatory
diseases.

A head or neck injury that results in damage to blood
vessels in the head or neck.

A tear in the wall of a blood vessel
located in the neck.

Symptoms

A
TIA is a warning: It means you are likely to have a stroke in the future. If
you think you are having a TIA, call 911. Early treatment can help prevent a
stroke. If you think you had a TIA but your symptoms went away, you
still need to call your doctor right away.

Symptoms of
transient ischemic attacks (TIAs) occur suddenly and
are always temporary. They usually go away in 10 to 20 minutes. TIA
symptoms are just like
stroke symptoms. They vary depending on which part of
the brain is affected. Common symptoms of TIA may include:

Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.

Sudden vision changes.

Sudden trouble speaking.

Sudden confusion or trouble understanding simple statements.

Sudden problems with walking or balance.

A sudden, severe headache that is different from past headaches.

If symptoms last longer than an hour, it might be more likely that you have had a stroke.

What Happens

A transient ischemic attack (TIA) is a
warning sign that a stroke may soon follow. Any symptoms of a TIA need to be
treated as an emergency.

After a TIA, 9 to 17 out of 100 people will have a stroke in less than 90 days.1 The risk of stroke is highest in the first 30 days after a TIA.

A TIA also may signal an increased risk for a
heart attack.
Atherosclerosis, which is hardening of the arteries,
affects blood vessels throughout the body, including arteries that supply blood
to the heart and brain. Atherosclerosis that affects the blood vessels in the
heart (coronary arteries) may cause chest pain or a heart attack.

What Increases Your Risk

The risk factors (things that increase risk) for transient ischemic attack (TIA) and stroke include those you can treat or change and those you can't change.

Treatment Overview

Getting help for a TIA

If you had symptoms of a TIA but you feel better now, you still need to see a doctor right away. A TIA is a sign that a stroke may soon follow. Prompt medical
treatment may prevent a stroke.

Treatment for a TIA

If you've had a transient ischemic attack (TIA), you may need further testing and treatment after you've been checked by your doctor. If you have a high risk of stroke, you may have to stay in the hospital for treatment.

Your treatment for a TIA may include taking medicines to prevent a stroke or having surgery to reopen narrow arteries.

Medicines may include aspirin,
clopidogrel, dipyridamole with aspirin, or warfarin.

If your
carotid arteries are significantly blocked, you may
need surgery to reopen the narrowed arteries (carotid endarterectomy).

Preventing another TIA or stroke

Your treatment will also focus on
preventing another
TIA or stroke. This may include:

Reducing high blood pressure, the most common risk factor for
stroke, by making changes to your diet and taking medicines that lower blood pressure.

Taking aspirin or another antiplatelet medicine to
prevent strokes.

Controlling
diabetes. Your doctor will advise that you try to keep
your blood sugar levels in a target range. To do this, you may
need to take oral medicines or insulin. Eating a healthy diet and getting
plenty of exercise will also help.

Getting a flu shot every year to
help you avoid getting sick from the
flu.

You may also need to make lifestyle changes such
as quitting smoking, eating heart-healthy foods, and being more active.

Prevention

You can help prevent a
transient ischemic attack (TIA) or stroke by controlling your
risk factors for
stroke.

Adopt a healthy lifestyle

Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.

Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.

Home Treatment

Home treatment is not appropriate for
a
transient ischemic attack (TIA). If you think you are
having a TIA, don't ignore the symptoms, and don't try to manage them at home.
If you had symptoms of a TIA but they went away, you still need to see a doctor right away.

Seek emergency medical care when symptoms first appear.
Prompt treatment may keep you from having a
stroke.

You can care for yourself at home by adopting healthy habits that help you prevent another TIA or stroke. To learn more, see Prevention.

Medications

Your doctor will probably prescribe
several medicines after you have had a
transient ischemic attack (TIA). Medicines to prevent
blood clots are typically used, because blood clots can cause TIAs and
strokes.

The types of medicines that
prevent clotting are:

Antiplatelet
medicines.

Anticoagulant medicines.

Cholesterol-lowering and blood pressure-lowering medicines
are also used to prevent TIAs and strokes.

Antiplatelet medicines

Aspirin (for example, Bayer) is most often used to prevent TIAs
and strokes.

Aspirin combined with dipyridamole (Aggrenox)
is a safe and effective alternative to aspirin.

Clopidogrel (Plavix) may be used
for people who cannot take aspirin.

Anticoagulants

Anticoagulants such as warfarin (for example, Coumadin) prevent blood clots from forming and keep existing blood clots from getting bigger. You may need to take this type of medicine after a TIA if you have atrial fibrillation or another condition that makes you more likely to have a stroke. For more information, see the topic Atrial Fibrillation.

Statins

Statins lower cholesterol and can greatly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who don't have heart disease or high cholesterol.2

Blood pressure medicines

If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:

Surgery

If you have a serious blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke.

The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA or stroke and how much your carotid arteries have narrowed.

Other Treatment

Carotid artery stenting (also called carotid angioplasty and stenting) is sometimes done as an alternative to surgery to prevent transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and
Stroke

NIH Neurological Institute

P.O. Box 5801

Bethesda, MD 20824

Phone:

1-800-352-9424

Phone:

(301) 496-5751

Web Address:

www.ninds.nih.gov

The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.

American Heart Association (AHA)

7272 Greenville Avenue

Dallas, TX 75231

Phone:

1-800-AHA-USA1 (1-800-242-8721)

Web Address:

www.heart.org

Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.

CardioSmart

Web Address:

www.cardiosmart.org

CardioSmart is an online education and support program that can be your partner in heart health. This website engages, informs, and empowers people to take part in their own care and to work well with their health care teams. It has tools and resources to help you prevent, treat, and/or manage heart diseases.

You can set health and wellness goals and track your progress with online tools. You can track your weight, waist measurement, blood pressure, and activity. You can use calculators to help you find your body mass index (BMI) and check your risk for heart problems. You can search for a cardiologist. And you can find medicine information and prepare for your next appointment. Also, you can join online communities to connect with peers and take heart-healthy challenges.

CardioSmart was designed by cardiovascular professionals at the American College of Cardiology, a nonprofit medical society. Members include doctors, nurses, and surgeons.

National Heart, Lung, and Blood Institute
(NHLBI)

P.O. Box 30105

Bethesda, MD 20824-0105

Phone:

(301) 592-8573

Fax:

(240) 629-3246

TDD:

(240) 629-3255

Email:

nhlbiinfo@nhlbi.nih.gov

Web Address:

www.nhlbi.nih.gov

The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:

Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

National Stroke Association

9707 East Easter Lane, Suite B

Centennial, CO 80112

Phone:

1-800-STROKES (1-800-787-6537)

Fax:

(303) 649-1328

Email:

info@stroke.org

Web Address:

www.stroke.org

This association provides education, information,
referrals, and research on stroke. Information specific to survivors,
caregivers, family, women, and children is included.

Society for Interventional Radiology

3975 Fair Ridge Dr.

400 North

Fairfax, VA 22033

Phone:

1-800-488-7284

Web Address:

www.sirweb.org

The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The website includes a section on patient information. This section gives information on therapies for various diseases and conditions. The website can also help you find a doctor.

References

Citations

Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.

Other Works Consulted

Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council, American Heart Association. Circulation, 97(5): 501–509. Also available online: http://circ.ahajournals.org/content/97/5/501.full.

Easton JD, et al. (2009). Definition and evaluation of transient ischemic attack: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke, 40(6): 2276–2293. Also available online: http://stroke.ahajournals.org/cgi/reprint/40/6/2276.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.

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